Head & Neck Flashcards
Subclavian structures from anterior to posterior
Subclavian vein Phrenic nerve Anterior scalene Subclavian artery Brachial plexus Middle scalene
Recurrent laryngeal innervates everything but this muscle?
What innervates this muscle?
Cricothyroid muscle.
Superior laryngeal nerve. Affects voice tone, high pitches
Treatment strategy for oral squamous cell CA based on size
> 4cm or node involvement -> WLE, modified radical neck dissection, adjuvant XRT
Salivary gland tumors.
- Most common malignant tumor? #2 most common malignant?
- MC benign tumor?
- Treatment for malignant salivary gland tumor? What if it’s invading the facial nerve?
- Most common malignant: mucoepidermoid. #2: adenoidcystic
- Most common benign: pleomorphic adenoma
- Rx: total parotidectomy with facial n. preservation, ipsilateral modified radical neck dissection, post-op XRT. If it involves the facial, you can get away with XRT only
Palpable node in the neck. Bx shows cancer. Unkn primary.
- What to do next?
- What is the most common site for unknown h&n primary?
- what is the treatment?
FNA of regional nodes
CT of head neck, chest +/-PET
OR for direct laryngoscopy, directed biopsies
- tonsil, followed by base of the tongue.
- have to take pt to OR regardless. Do ipsilateral modified radical neck dissection, bilateral XRT
Most common site for oral cavity cancer. Why.
When to do flap reconstruction
Lower lip. Sun exposure.if over half of the lip is resected then reconstruct
Painless protuberance in the bony part of the mouth. Treatment?
Torus peletinus. Do nothing
Ebstein barr associated with what head and neck cancer? Treatment?
Nasopharyngeal squamous cell cancer
Radiation
What is Frey syndrome? Why/how does it happen?
Auriculotemporal nerve injury. Interacts with the sympathetics
Post-op lap CCY. High fevers and big swelling at the angle of the jaw. What is it? What organism? Treatment?
Suppurative parotiditis. Staph aureus
Abx, supportive care. I&D if collection
What is the most common original of the brachial cleft cyst?
2nd arch
The tract of the brachial cleft cyst goes over or under cranial nerve 12?
Over or under cranial nerve 9?
Relation to internal and external carotid?
Relation to SCM?
Ultimately goes into what structure?
Over CN12 Over CN9 Between the bifurcation Anterior to SCM ultimately goes into the tonsil
The entire thyroid gland rises from the thyroglossal duct tract except for what part?
The tubercle of zuckerkandl which rises from the 4th pouch along with the superior paras
Sarcoidosis is caseating or non-caseating granulomatous changes?
Non-caseating.
Caseating: TB
If you biopsy a head and neck lymphadenopathy and see metastatic cancer? What is the most likely primary?
Squamous cell CA of upper aerodigestive tracts
What is the T staging for any head and neck tumors?
T1: <2 cm
T2: 2-4 cm
T3: >4 cm
T4: any that invades adjacent structures
Treatment regimen for head and neck cancer based on T staging?
Given that the pt doesn’t have any physical exam or CT findings of nodes, what do you do with neck for each of the T stages?
T1 - T2: surgery
T3 - T4: surgery with post-op radiation or chemo
Only T2 lesions needs b/l neck dissection.
T1: low chance of nodal disease
T2: 30% chance of nodal disease
T3-T4: you’re giving post-op radiation anyway
What is the main complication from radiation to face/mouth cancer?
Osteoradionecrosis. Bone becomes necrotic. Gets infected
CT size cutoff for neck nodes
N1: < 3 cm
N2: 3-6 cm
N3: >6 cm
N2a: 3-6cm single node
N2b: multiple nodes
N2c: contralateral node
What does the accessory nerve innervate?
Trapezius and SCM
Which type of thyroid cancer most likely to be when there’s calcifications in the thyroid?
Papillary
80% of parotid tumors are benign or malignant?
What is the most common benign tumor?
What is the most common malignant tumor?
80% of parotid is benign
Most common benign: pleomorphic adenoma
Most common malignant: mucoepidermoid carcinoma
Do cystic hygromas carry any malignancy risk?
Can they be diagnosed on prenatal ultrasound?
No
Yes
Which organ do you need to take out when removing a 3rd and 4th branchial remnant?
What about 2nd remnant?
3rd and 4th: thyroid
2nd: tonsil
T/F: acutely infected branchial cleft cyst needs immediate operation
The incision should be (transverse/longitudinal) over the cyst
F. Abx for several weeks first
Transverse incision will improve cosmesis
What are the borders of the submental triangle
Anterior belly of the digadtrics
Hyoid bone
Symphysis menti
floor: mylohyoid
“pushing edges” on the histological exam rather than invading
Verrucous carcinoma. It’s a variant of the sq cell ca
Most common site of minor salivary gland malignancies?
Palate. 50% of all minor salivary gland malignancy
Why should you never do a cric in kids?
Cricoid cartilage is the narrowest part of the airway in kids. It’ll cause airway stenosis
> 12yo you can do it
What the F is frey syndrome?
How do you treat it?
Sweating and flushing of a patch of skin near the ear that occurs when someone is eating
It occurs due to inappropriate regrowth of the parasympathetic auriculotemporal nerve into the sweat glands overlying the parotid gland
Apply antiperspirant to involved skin
What innervates the sensation over the skin behind ears?
Greater auricular nerve
Parathyroid cancer carries worse prognosis for
- men vs women?
- young age vs old age at diagnosis?
- men are worse
- old age at diagnosis is worse
What are the borders of the submandibular triangle?
Anterior belly, posterior belly of the digadtrics, Mandible.
This is the triangle right next to the submantle triangle
Hyoid bone
Anterior digadtrics
What is the most common incision for parotid surgery?
Modified Blair incision
Starts in the preauricular skin and extends around the lobule over the mastoid tip then curves around down the neck
What is the second most common benign parotid gland
Monomorphic adenoma aka warthin tumor
Open trach vs perc trach.
Difference in icu los? Cost? Infection rate?
Only difference is lower infection rate in perc trach
What is the N staging for head and neck cancer?
N1: single ipsilateral node < 3cm
N2: single ipsilateral node 3 - 6cm OR multiple ipsilateral nodes or bilateral
N3: > 6cm
Enlarging parotid gland mass with facial droop. Is it pleomorphic adenoma?
No. When it’s enlarging and facial droop think cancer. Mucoepidermoid is most common
Most common morbidity after radical neck dissection?
Shoulder dysfunction because of accessory nerve
Denervated trapezius. Frozen shoulder
What forms the floor of the submental triangle?
Mylohyoid muscle
Typically where is the facial nerve trunk in relation to
Tragal pointer?
Tympanomastoid suture line?
1cm inferior to the tragal pointer
6-8mm below the tympanomastoid suture line at the lvl of the belly of the posterior digastric muscle.
For parotidectomy, what is the rate of facial nerve dysfunction?
What is the prognosis once you get facial nerve dysfunction? What is the rate of permanent dysfunction?
20-40%. Very common
Prognosis: most recover within a year. Permanent dysfunction only 4%
